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WHIPPLE PROCEDURE IMPROVES PANCREATIC CANCER SURVIVAL
A complex operation for pancreatic cancer, called the Whipple procedure, has been shown to improve patients' long-term survival even if the whole tumor cannot be removed, according to a Johns Hopkins study.
At present, most surgeons perform a bile duct or gastric bypass and not a Whipple procedure (pancreaticoduodenectomy) under these conditions, says Keith Lillemoe, M.D., the study's lead author and a professor of surgery. The study involved 64 patients who underwent the Whipple procedure and had some cancer tissue remaining after surgery, and 62 patients who underwent a bile duct or gastric bypass instead of the Whipple procedure because the whole tumor could not be removed. All patients were operated on at Hopkins between 1986 to 1994. In the Whipple procedure, part of the pancreas, all of the duodenum, gallbladder, bile duct and sometimes part of the stomach are removed.
The Whipple procedure patients had about three days longer hospital stay, but 10 percent fewer post-operative complications. The one-, two- and three-year survival rates for Whipple procedure patients were 63 percent, 16 percent and six percent, versus 39 percent, eight percent and zero for bypass patients, according to the study, which recently was presented at a meeting of the Southern Surgical Association.
"The results suggest that a combination of the Whipple procedure and post-operative radiation and chemotherapy can improve long-term survival compared with surgical bypass in patients with advanced pancreatic cancer," says Lillemoe.
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SENIORS HELP THEMSELVES BY HELPING KIDS
A team of experts at Johns Hopkins, the National Service Corporation and Public/Private Ventures have launched a new service program, the Experience Corps, that puts elderly Americans into productive roles at resource-starved elementary schools.
By working with the schools, the program matches adults 55 and older with children who need mentors, tutors and enrichment programs both during and after school. Uniquely, the program groups seniors in teams of 5-10, and places them in "meaningful roles"-- positions that allow them to make significant contributions to the community--for at least 15 hours every week.
"There is often a loss of opportunity to be active as people get older and retire. That can lead to loss of self-esteem and supportive social contacts, and possibly a decline in health," says Linda Fried, M.D., M.P.H., an associate professor of medicine at Hopkins.
At the same time, Fried says, many children are growing up in homes and neighborhoods with little guidance from adults. Seniors can help, Fried suggests.
In the pilot phase in five cities--New York City; Portland, OR; Minneapolis; Philadelphia; and Port Arthur, TX--older adults will be recruited, assembled into teams and receive special training.
Fried and Hopkins colleaugue, Barbara Wasik, Ph.D., in collaboration with Public/Private Ventures and the National Service Corporation, will evaluate the program's impact on seniors and children after a period of 18 months.
Partial funding for this phase of the Experience Corps was provided by the National Service Corporation and the Retirement Research Foundation.
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NEW APPROACH TO RESTORING USE TO INJURED ARM
Johns Hopkins surgeons are taking a new approach to restoring function to arms left paralyzed by injury.
The brachial plexus nerves, a bundle of nerves running along the neck and down the arm, often are damaged by traffic accidents, gunshots, stabbings and difficult births. When these nerves, which control feeling and movement from the shoulder to the fingers, are stretched, cut or yanked from the spinal cord, partial or complete paralysis may occur.
"These patients are often told there's no hope, even that amputation is the best option, but we're taking an aggressive approach to give them the chance to use their arms again," says Allan Belzberg, M.D., an assistant professor of neurosurgery.
Surgeons at Hopkins and a few other medical centers are splicing the damaged nerves together the way a damaged electrical cable is repaired, says Belzberg. Using an operating microscope, surgeons graft nerves from the rib cage into the injured brachial plexus nerve group. And in a radical new approach, if the opposite side of the brachial plexus group still works, a portion of it is transferred to the injured area and grafted into place.
Many patients have benefited from nerve graft surgery at Hopkins. Recently, three patients, each with an arm completely paralyzed, underwent the experimental surgery. All have regained some sensation and movement, although it will take many months for the nerves and muscles to heal and final function to be determined.
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CHILDHOOD MILK, EGG AND PEANUT ALLERGIES LINKED TO PARENTS
Sixty to eighty percent of infants whose parents suffer from hayfever, eczema or asthma, are at high risk for developing food allergies. Those children might benefit from avoiding cow's milk, eggs and peanuts early in life, say pediatricians at the Johns Hopkins Children's Center.
Allergies passed down from parent to child can lead to abnormal immune responses such as wheezing, asthma, nasal congestion, eczema and hives. In extreme cases, the reactions can be life-threatening.
According to Hugh Sampson, M.D., professor of pediatrics at the Children's Center, allergies to food proteins may become progressively worse following each exposure. Parents should consider not introducing young, high-risk children to the most common offenders, he says. He recommends excluding cow's milk from the diet of high-risk infants for the first year of life, eggs for the first 18 months, and peanuts for the first three years. That includes foods like pudding and peanut butter, made from these allergy-causing foods.
"Once a person has become sensitized, consumption of only milligrams of a food may be sufficient to induce an allergic reaction. As little as half a peanut can cause a dangerous response, so it's best not to become sensitized at all," says Sampson.
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